Radiology Coding Alert

Realize which codes to use for AB-MRI procedures.

Radiologists perform breast magnetic resonance imaging (MRI) exams to capture clear images of the patient’s breasts to assess their condition. The detailed breast MRI images allow providers to precisely identify any abnormalities or evaluate symptoms the patient may be experiencing.

Read on to understand when breast MRI exams are performed and how to code the procedures correctly.

Know When a Provider Orders a Breast MRI

A provider will order a breast MRI exam for a patient for several reasons, including:

• High risk of developing breast cancer due to family history and other factors;
• Experiencing signs or symptoms that are consistent with breast cancer;
• Determining the extent of a confirmed breast cancer diagnosis; and
• Evaluating possible complications with silicone breast implant(s).

“A clinician may also order an MRI of the breast when a patient has dense breasts, and it makes it difficult to detect abnormalities through traditional screening mammograms,” says Chelsea Kemp, RHIA, CCS, COC, CPC, CPCO, CDEO, CPMA, CRC, CCC, CEDC, CGIC, AAPC Approved Instructor, outpatient & professional coding educator/auditor, Yale New Haven Health in New Haven, Connecticut. Dense breasts, which can be specified as heterogeneously dense or extremely dense, are coded to R92.33- (Mammographic heterogeneous density of breast) and R92.34- (Mammographic extreme density of breast), respectively. Code R92.30 (Dense breasts, unspecified) is reserved for instances where the provider doesn’t specify the type of breast density.

As indicated above, providers will use breast MRI to evaluate the patient for breast cancer. While providers also use screening mammography and diagnostic mammography procedures to check for possible breast cancer, a breast MRI differs in that the MRI requires the use of contrast. The contrast medium is injected intravenously (into the patient’s vein), which makes any abnormalities easier to view on the MRI images.

Documentation: If a radiologist finds that a patient’s breast tissue is dense and needs a breast MRI to accurately evaluate the body structure for any abnormalities, then the provider may be required to obtain a separate order for the exam. Typically, a separate order is needed for outpatient facilities and independent diagnostic testing facilities (IDTFs) if a screening mammography reveals a suspicious finding.

Master the Breast MRI Codes

When a radiologist or radiology technologist performs a breast MRI, you’ll report the procedure using one of the following codes listed in the CPT^® code set:

• 77046 (Magnetic resonance imaging, breast, without contrast material; unilateral)
• 77047 (… bilateral)
• 77048 (Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral)
• 77049 (… bilateral)

Each of the above codes is based on laterality, which means you’ll report one of the unilateral codes (77046 or 77048) if the provider performs the procedure on only one of the patient’s breasts. You’ll choose from 77047 and 77049 if the MRI exam is performed on both of the patient’s breasts.

You’ll select a code from 77046-77047 when the provider performs the breast MRI without using contrast material. On the other hand, you’ll use 77048 or 77049 when the provider captures images without contrast, then administers contrast and captures additional images. If the provider uses computer-aided detection (CAD) to analyze the images to evaluate possible abnormalities in addition to before and after contrast administration, then you’ll still use 77048 or 77049 to report the procedure. The descriptors for 77048 and 77049 both feature the phrase “when performed,” so CAD use isn’t required to report the codes, but it is included if the provider uses the technology when analyzing the images.

Report a Breast MRI With Contrast Only

Each of the breast MRI codes listed above cover the procedure without using contrast and without/with contrast, but what if the provider performs the procedure with contrast only?

“According to CPT^® Assistant, Volume 29, Issue 8, a contrast-only breast MRI should be reported with an unlisted CPT^® code, which in this case is 76498 (Unlisted magnetic resonance procedure (eg, diagnostic, interventional)),” Kemp says.

At the same time, reviewing your individual payer’s preferences or reaching out to the payer wouldn’t hurt in these rare situations. “It is best practice to contact the payer for clarification on their billing and coding policy pertaining to breast MRIs with contrast (reporting an unlisted code, append a modifier, etc.) as the current CPT^® code set only includes codes for breast MRIs performed either without contrast or without/with contrast,” says Taylor Berrena, COC, CPC, CPB, CRC, CPMA, CEMC, CFPC, CHONC, coder II at MD Anderson Cancer Center at Cooper in Yorktown, Virginia.

What is an Abbreviated Breast MRI?

When a provider determines that a patient has dense breast tissue, the provider may perform an abbreviated breast MRI (AB-MRI) for a cancer screening. The dense breast tissue makes it difficult to visualize any breast tissue abnormalities during a screening mammography or a diagnostic mammography, which makes an MRI a preferred imaging choice for providers. During an AB-MRI, the provider captures images before and after contrast administration, but the provider captures fewer image sequences than a regular breast MRI procedure, which means the AB-MRI can take considerably less time than a traditional MRI.

However, while the procedure has a different name, you’ll use the same codes for the procedure. You’ll assign 77048 for a unilateral AB-MRI or 77049 for a bilateral AB-MRI, according to CPT^® Assistant, Volume 29, Issue 12. You don’t need to append the code with a modifier, such as modifier 52 (Reduced services), to indicate a service reduction for the abbreviated procedure.

The CPT^® code set doesn’t specify any requirements for a breast MRI, aside from contrast use and laterality, which means that you can correctly assign either 77048 or 77049 for the procedure.

“No modifiers should be needed to report an AB-MRI because the CPT^® code set doesn’t indicate what constitutes a complete versus an AB-MRI in the code descriptions or guidelines (no mentions of what or how many anatomic structures that must be imaged, how many sequences or views, etc.). Therefore, the expectation is that the breast MRI will be performed according to the needs of the patient,” Berrena says.